Migraine Headache Symptoms, Causes, and the Relationship to Sleep

Poor Sleep Can Contribute to Headaches

Migraine headaches with aura of lights are commonly associated with poor sleep
Migraine headaches with aura of lights are commonly associated with poor sleep. CSA Plastock/CSA Images/Getty Images

Sleep and headaches have a close association, and migraine headaches are no exception. How do migraine headaches relate to sleep? Learn about the symptoms, causes, and role of sleep in classic and common migraine disorders.

Understanding the Basics of Headaches and Sleep

Headaches are generally differentiated based on their most common symptoms. These pains may occur on one side (unilateral) or both sides (bilateral) of the head.

They may vary in severity as well as duration. Sleep-related headaches are defined as occurring during sleep or immediately upon awakening.

Most headaches associated with sleep also occur during wakefulness. These headaches include migraines, cluster headaches, and chronic paroxysmal hemicrania. There are also conditions that occur only during sleep, such as hypnic headaches. Many headaches occur due to other medical, neurological, psychiatric, or sleep disorder conditions.

Importantly, headache and sleep and dependent on similar anatomy and chemicals within the brain. For example, the brainstem and hypothalamus have roles in both headache and sleep processes. Many of the neurotransmitters overlap as well, including adenosine and orexin and the hormone melatonin.

It is estimated that of the 17% who come to a headache clinic with complaints of nighttime or early morning headaches, at least half have a headache that is due to an underlying sleep disorder.

What Causes Migraine Headaches?

Migraines tend to be triggered by common factors. Sleep deprivation, or changes in sleep patterns, may contribute. Other potential causes of migraine headaches include:

  • Stress
  • Relaxation
  • Weather changes (including barometric pressure)
  • Hypoglycemia (low blood sugar due to fasting)
  • Food triggers (chocolate, Chinese food with MSG, alcohol)

It is estimated that more than 80 percent of people with migraine have a family history of the condition. There are some subtypes with a strong genetic predisposition, including familial hemiplegic migraine that is autosomal dominant with mutations identified on chromosomes 1 and 19.

Most sleep-related migraines tend to increase in frequency with age, often starting in the second or third decade of life. There is an earlier onset observed in men. In later life, the headaches may become less severe and migraines often stop in women after menopause, suggesting a hormonal influence.

The Symptoms of Migraine Headaches

Migraines can be quite severe and may be debilitating, interfering with professional and social responsibilities. Most describe a headache intensity that is moderate to severe, often unilateral and pulsating. The pain lasts from four to 72 hours. It may be worsened by physical activity. Migraines are commonly associated with nausea and aversion to light and noise (called photophobia and phonophobia, respectively).

There are several subtypes of migraine, including:

  • Classic migraine: characterized by an aura that lasts from four to 60 minutes, sometimes continuing or beginning in the headache phase. The aura may be a partial loss of vision or shimmering lights or patterns (called scintillating scotomas).
  • Common migraine: does not start with an aura.
  • Complicated migraine: associated with other deficits, such as numbness or tingling, weakness, or speech abnormalities. Rarely, it may lead to vertigo, tinnitus (ringing in the ears), slurred speech, double vision, clumsiness, and even impaired consciousness.
  • Familial migraine with hemiplegia: may be associated with weakness on the same or opposite side of the body as compared to the headache.

Many people will simply experience classic or common migraines; the other conditions occur far less frequently.

Migraines and the Relationship to Sleep

Migraines may occur during the day or during sleep. In fact, sleep is often associated with headache relief. When afflicted, someone with a migraine will often retire to a quiet, dark room until the headache relents.

Interestingly, it is estimated that 50 percent of migraine attacks occur between 4 AM and 9 AM. This is the time that cortisol levels rise to wake a person from sleep. When migraines occur out of sleep, there is not a clear association with any specific sleep stage. They have been reported to be linked to N3 and REM sleep.

If you suffer from recurrent migraine headaches that interfere with your ability to function, and sleep, start by speaking with your doctor. It can be helpful to consider evaluation by a general neurologist, headache specialist, or sleep specialist, as needed. There are effective treatments, including medications for prevention and acute relief, available to help you to sleep and feel better.

Sources:

American Academy of Sleep Medicine. International classification of sleep disorders, 3rd ed. Darien, IL: American Academy of Sleep Medicine, 2014

Bartleson JD, Black DF, Swanson JW. Cranial and Facial Pain. pp. 263-269. In Bradley

Brennan KC, Charles A. Sleep and headache. Semin Neurol 2009; 29:406-417.

International Headache Society Classification Subcommittee. 2004, International classification of headache disorders, 2nd ed., Cephalgia, vol. 24, suppl. 1, pp. 1-60.

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